MEDICARE: DR. JENNIFER LYNN TONNESON DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4738	MN

General Provider Information

NPI Number	:	1760527287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER LYNN TONNESON DC

Provider Business Mailing Address
First Line	:	21080 OLINDA TRL N
Second Line	:	BOX 4
City	:	SCANDIA
State	:	MN
Zip	:	55073-9492
Country	:	US
Telephone Number	:	651-433-5750
Fax Number	:	651-433-5750

Provider Business Practice Location Address
First Line	:	21080 OLINDA TRL N
Second Line	:	BOX 4
City	:	SCANDIA
State	:	MN
Zip	:	55073-9492
Country	:	US
Telephone Number	:	651-433-5750
Fax Number	:	651-433-5750

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	09/14/2012

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